No Maidan for mental health?

One of my most favorite slogans is one that was developed by the Mental Health department of the World Health Organization, some fifteen years ago: “No health without mental health”. It is a slogan that summarizes the understanding that mental health is an integral part of health care in all its aspects, and that no part of health care exists that has no mental health component.

I would go a bit further, and claim that no civil society exists unless people with mental health problems are accepted as equal, that their needs are met, they are adequately taken care of and – last but not least – that they are dealt with equally, in all respects. Once a society agrees to compromise on that, it finds itself on a sliding slope.

Twenty five years ago I came to Ukraine for the first time, seduced by my friend who convinced me that working in Ukraine would have much more perspective than staying in Moscow and compete with the planeloads of other foreigners who came to the disintegrating USSR as a land of endless possibilities and endless hopes for a better future.

From the very start my focus was mental health, psychiatry. During one of my first visits, in the summer of 1991, I entered what can best be described as a ”close encounter with hell”: the psycho-gerontological department of the Pavlov Psychiatric Hospital in Kyiv. The then director of the hospital was on holiday and staff dared to show me what was going on behind closed doors. It was an experience I will never forget: 60-70 patients locked up in a cellar, dressed in rags, sometimes three on two bed shoved together, with an unbearable stench from dysfunctional sanitary facilities. It was sheer horror, beyond anything I had seen until then. When I left the department I was in shock, and my Ukrainian companion in tears. I can still imagine the terrible stench in my nostrils.

For twenty-five years I battled for a different, more humane mental health care in Ukraine. I do not like to boast, but there is no country in which I invested so much of my time, energy and emotions. The country became my own, like home, I developed so many friendships for life, yet one thing never changed: psychiatry itself. Sure, it does not have all the sharp corners of the early 1990s, when in an internat three-four nurses had to take care of more than 300 bed-ridden patients who were locked up in huge coffins from which they could only leave horizontally and where the same stench and human misery as in the “Pavlovka” prevailed. But the system as such didn’t change; it remained highly custodial, institutional and inhumane, and had little in common with what real mental health care services should look like.

Then came Maidan, this extraordinary “once-in-a-lifetime” experience when a nation stands up against its corrupt leaders and manages to send them to hell – in this case to Russia. The extraordinary feeling evoked by seeing how the first post-Soviet generation rid itself of the Soviet past and took the lead in putting the country on a new path, gave me wings – and high hopes that now finally something could be done for psychiatry as well. Finally we would be able to end the idiocy of Soviet psychiatry, the incompetence of the psychiatric nomenklatura in the country, the total disrespect for the rights of persons with mental illness and their families. Finally we could join hands with the many mental health professionals in the country who despair, who so much crave for something different, who suffer because their patients suffer, and start building a modern mental health care service.

I am an optimist, for sure. But I am also a realist. Thirty-eight years of working in the Soviet Union and what came after it, is quite enough to pull you down to reality, to see where hopes end and reality begins. But I really thought that now something could be changed, and with me many professionals in the field felt the same.

Alas, more than a year after Maidan I have to admit that the change has not come, that the old ways and old structures are more steadfast and resistant than phlegm in cystic fibrosis, which rids the patient of the ability to breath and eventually results in a painful suffocating death. Somehow the desire to make a fundamental and definite break with the past is not there. I am not talking about the mental health professionals, the majority of whom I deeply respect because any “normal” person would have quit their job long ago if they had to work in such conditions. I am talking about the political will, all the way up to the Council of Ministers and the President. Somehow they do not understand that for instance “feeding” patients at the Pavlov Psychiatric Hospital in Kyiv with only 0,10 eurocents per day is a criminal act that should never ever be condoned. And this is just one little example, to which so many others can be added…

The truth is, people with mental illness are considered to be useless “unproductive elements”. This was the case in the USSR, but in Ukraine this never changed after independence. And thus the idea that a society should invest in humane, ethical and community-based services is considered as a “luxury” and outlandish. Yet mental health is the mirror of society. A country that cannot take care of its citizens in need in a humane and caring manner, is not civilized, no democracy, and not worth the respect of the rest of the world. Ukraine has hundreds thousands of citizens who are in desperate need of help, of acceptance, of being integrated into society instead of being locked away in horrible institutions. They too had their Maidan. They too hoped for change.